Stimulant Use Disorder Flashcards

1
Q

Stimulant use disorder (SUD) is classified as…

A

An inappropriate use of stimulants, leading to clinically significant impairment/distress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Diagnostic criteria as per the DSM defines 3 categories, including…

A

Problems with USE - using large amounts, more time spent with use, repeated attempts to control use

Problems with LIFESTYLE - physical/psych/social/interpersonal problems related to use, activities given up, neglected major roles, hazardous use

Problems with PHYSIOLOGY - craving, tolerance, withdrawal

Same as OUD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Most stimulants used are derivatives of…

A

Amphetamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Stimulants physiological effect is to…

Stimulants are often refered to as…

A

Increase motivation, concentration, mood, energy, and wakefulness

Sympathomimetics - mimic physiological effects of epinephrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The cycle of SUD is often…

A

Binging on stimulant - stimulant wears off = crash - experience cravings, repeat.

Tolerance + addiction end up developing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Strong stimulants include…

A

Cocaine
Methamphetamine
MDMA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The mechanism of stimulants is…

A

Increasing CNS + ANS activity
Effect reward pathway by increasing DA concentrations - outcome similar between stimulants, but intensity will vary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cocaine and amphetamines are stronger stimulants pharmacologically, because…

A

Cocaine prevents re-uptake only of DA, 5-HT, NE
Amphetamines cause RELEASE of NT (DA, 5-HT, NE) from storage sites, and to various degrees also inhibit re-uptake

Long-term use depletes stores of NT which leads to tolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Stimulant effect on the CNS involves…

A

Intense euphoria
Increased alertness, concentration, talkativeness, sexual behaviour
Decreased appetite, fatigue

May see anxiety, agitation, nausea, tremors, twitches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Stimulant effect on the ANS involves…

A

Increase in body temperature, heart rate, blood pressure, respiratory rate, constriction of blood vessels (dilated pupils)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Overdose of stimulants can result in…

A

Seizures, coma, cardiac toxicity, respiratory arrest, brain hemorrhage, death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Immediate complications of stimulants may include…

A

Increased risk of violent/illegal behaviours
Increased engagement in risky sexual behaviour
Psychosis
Irritability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Long-term complications of stimulants may include…

A

Dental decay, weight loss, picking at skin with scabs, panic attacks
Brain changes, memory loss
Chronic psychotic disorders

Psychotic disorders can be secondary to repeated use, or unmasking of a primary disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

A patient with acute stimulant intoxication or overdose may present with the following symptoms…

CNS, ANS overdrive

A

Mania, psychosis, paranoia, severe delirium

Increased BP, chest pain, agitation, sweating, skin-picking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Stimulant intoxication management is usually…

A

Supportive, unless patient is experiencing delusions, autonomic hyperactivity, or overtly agitated

Or severe crisis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

For stimulant intoxication management, if a patient is acutely agitated, we could…

A

Consider BZD - lorazepam PRN
If does not help or in presence of psychotic sx’s, could add low dose AP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

For stimulant intoxication management, if a patient is experiencing psychotic symptoms, we could…

A

Give low dose antipsychotic (risperidone 0.5-2mg/day, olanzapine 2.5-7.5 mg/day)

Delusions are often self-remitting without treatment (unless patient has been experiencing them chronically)

18
Q

For stimulant intoxication management, if a patient is experiencing cardiovascular complications, we could…

A

Give anti-arrythmic agents if arrythmia present
Give beta-blocker/clonidine for tachycardia +/- HTN

19
Q

For stimulant intoxication management, if a patient is experiencing seizures, we could…

A

Give anti-seizure medication if currently seizing (diazepam IV, midazolam IM)

No role in prevention

20
Q

Stage 1 of stimulant withdrawal starts…

Crash

A

Within hours, and lasts 4-7 days

21
Q

Signs and symptoms of stage 1 withdrawal include…

A

Hypersomnolence
Hyperphagia

Fatigue
Marked dysphoria
Fatigue, anorexia

22
Q

Stage 2 of stimulant withdrawal starts…

A

After the first week and can last up to 10 weeks

23
Q

Signs and symptoms of stage 2 withdrawal include…

A

1st week is normal (euthymia, little anxiety, minimal craving, normal sleep)

Subsequent weeks - anhedonia, increased anxiety, depression, fatigue
Extreme craving + fixation on use

24
Q

From a pharm perspective, stimulant withdrawal management is primarily…

A

Non-pharm: planning for addictions counselling, support, community support, rehab options, housing needs

25
If post-acute hyperarousal/anxiety persists in stimulant withdrawal, we could...
Continue BZD's for a little longer Trial mirtazapine (mixed results)
26
Goals of therapy in treating SUD include...
Achieving abstinence Maintaining abstinence (tx ongoing withdrawal, craving, addictions) Treating comorbid conditions (depression, anxiety) Preventing harm to self and others
27
Sustained neurophysiological changes from methamphetamine usage leads to...
Depressed mood Anhedonia Cognitive impairment Poor health
28
The biggest factor leading to relapse and challenges in managing SUD is...
Cravings
29
Antidepressants were thought to help with SUD because ____, BUT...
5-HT may attenuate reinforcing effects of amphetamine and counter withdrawal symptoms of depression, but mixed results have been seen with abstinence ## Footnote Mirtazapine had 1 positive RCT for amphetamine abstinence, but still not solid evidence
30
Bottom line: antidepressant usage for abstinence is...
Mostly ineffective, but may have positive mood-related results. Use according to depression/anxiety guidelines if indicated
31
Rationale for AP usage in SUD was ____, however...
They could counterbalance excess DA actvitity and restore NT pathways; however risked promoting cravings due to decreased dopamine increasing negative symptoms
32
AP's efficacy in SUD treatment showed...
No difference in any treatment outcomes (tx retention, abstinence, reduced use) Aripiprazole showed increased cravings and use, likely due to impulse control issue
33
We should use AP's in SUD treatment if...
Indicated, according to psychosis guidelines. Review need after 6 months.
34
Rationale for considering prescribed stimulants for SUD was...
Substitution/replacement therapy, similar to OAT
35
Studies have shown that prescribed stimulants for SUD was...
Mixed results - possible reduction in use or cravings, but usually no difference in treatment outcomes were observed Generally not recommended due to risk of worsening psychosis, and mood lability
36
Rationale for considering dopamine agonists in SUD was that...
Chronic stimulant use led to DA depletion
37
Studies have found that dopamine agonists....
General results were not promising - some possible benefit in severe withdrawal
38
Evidence of modafinil is SUD is...
Mixed - possibly useful to reduec cocaine use, but has negative trials and risk of increased effect with concurrent stimulant usage.
39
Evidence for bupropion + naltrexone is...
Statsitically significant compared to placebo; but still has a low response rate overall
40
Mainstay of tx for SUD is...
Non-pharm: 1st line = psychosocial approaches (CBT, contingency management, addictions treatment) ## Footnote Know where we can refer patients to
41
The pharmacist role in SUD is...
Elimination of unnecessary/non-beneficial medications Elimination of harmful medications (long term BZD, stimulants) Help identify + treat comorbid mental or physical conditions ## Footnote For other conditions treat according to guidelines independent of substance use, but also consider individual risk factors